MEDICARE: KAREN GRIFFITH OD A PROFESSIONAL OPTOMETRY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9002TL	CA

General Provider Information

NPI Number	:	1992944185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN GRIFFITH OD A PROFESSIONAL OPTOMETRY CORPORATION

Provider Business Mailing Address
First Line	:	320 PETALUMA BLVD S
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-4245
Country	:	US
Telephone Number	:	707-762-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 PETALUMA BLVD S
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-4245
Country	:	US
Telephone Number	:	707-762-8643
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN GRIFFITH
Credential	:	OD
Telephone Number	:	707-762-8643

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	05/01/2009

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